Corneal collagen cross-linking in Australia, before and during the COVID-19 pandemic

ABSTRACT

Purpose: Corneal collagen cross-linking (CCXL) is a minimally invasive treatment for progressive corneal ectatic disorders, recently introduced on the Australian Medicare Benefits Schedule in May 2018. We aim to explore CCXL service rates over time in Australia and investigate potential changes during the COVID-19 pandemic. Method(s) Retrospective analysis of CCXL services in Australia between 2018 and 2021, as recorded by Medicare. We used Poisson regression to explore changes in service rates with time, and to compare differences in distribution by age, sex and state/territory. Result(s) A total of 8009 CCXL services were performed during the study period, with the majority for males (66.5%), those aged 15-24 years (40.5%) and in Victoria (27.7%). CCXL rates tended to increase annually, rising from 7.55 (in 2018) to 9.15 (in 2021) services per 100 000 people. While CCXL rates increased by 14% between 2019 and 2020 (service rate ratio [RR] 1.14, 95% confidence interval [CI] 1.07-1.20), there was a 35% reduction between March and April 2020 when the COVID-19 pandemic began (RR 0.65, 95% CI 0.52-0.82). CCXL rates subsequently increased by 99% between April and August 2020 (RR 1.99, 95% CI 1.60-2.48). Conclusion(s) CCXL service rates increased annually in Australia from 2018. This could be attributable to increased access to treatment for progressive corneal ectasia, and/or an increasing burden of disease. CCXL rates decreased transiently early in 2020, likely due to lockdowns and elective surgery restrictions during the initial COVID-19 pandemic.